Genitourinary Tract Injuries •

Question 1

Genitourinary Tract Injuries: 4 big etiologies

Answer 1

Blunt Trauma
Penetrating Trauma
Acceleration/Deceleration Injury
Iatrogenic

Question 2

blunt Genitourinary Tract trauma: often associated with ______

Answer 2

pelvic fractures

Question 3

from a blunt trauma, Renal parenchymal tears/laceration can be of two kinds:

Answer 3

1.-: non-communicating (hematoma) vs.
2.- communicating (urine
extravasation, hematuria)

Question 4

a blunt trauma of the ureter is ____. And can be localted at

Answer 4

uretero-pelvic junction

Question 5

bladder can have two types of rupture:

Answer 5

– extraperitoneal rupture of bladder from pelvic fracture fragments
– intraperitoneal rupture of bladder from trauma and full bladder

Question 6

urethra can have two types of injuries:

Answer 6

– posterior urethral injuries: MVCs, falls, pelvic fractures

– anterior urethral injuries: blunt trauma to perineum, straddle injuries/direct strikes

Question 7

acceleration/deceleration injury affects the renal pedicle by

Answer 7

high mortality rate (laceration and thrombosis of renal artery, renal vein, and their branches)

Question 8

GU history

Answer 8

• mechanism of injury
• hematuria (microscopic or gross), blood on underwear
• dysuria, urinary retention
• history of hypotension

Question 9

GU Physical Exam

Answer 9

• abdominal pain, flank pain, CVA tenderness, upper quadrant mass, perineal lacerations
• DRE: sphincter tone, position of prostate, presence of blood
• scrotum: ecchymoses, lacerations, testicular disruption, hematomas
• bimanual exam, speculum exam

Question 10

In case of a • extraperitoneal bladder rupture we will see _______

Answer 10

pelvic instability, suprapubic tenderness from mass of urine or
extravasated blood

Question 11

In case of a intraperitoneal bladder rupture we will see ______

Answer 11

acute abdomen

Question 12

In case of a urethral injury we will see:

Answer 12

perineal ecchymosis, scrotal hematoma, blood at penile meatus, high riding prostate,
pelvic fractures

Question 13

GU Trauma Investigations

• urethra:

Answer 13

retrograde urethrography

Question 14

GU Trauma Investigations • bladder:

Answer 14

U/A, CT scan, urethrogram ± retrograde cystoscopy ± cystogram (distended bladder + postvoid)

Question 15

GU Trauma Investigations

• ureter:

Answer 15

retrograde ureterogram

Question 16

GU Trauma Investigations • renal:

Answer 16

CT scan (best, if hemodynamically stable), intravenous pyelogram

Question 17

Gross hematuria suggests ______injury

Answer 17

bladder

Question 18

In the case of gross hematuria, the GU
system is investigated from_____to
_____ (i.e. urethrogram, cystogram, etc.)

Answer 18

distal

proximal

Question 19

renal Management

minor injuries:

Answer 19

conservative management

◆ bedrest, hydration, analgesia, antibiotics

Question 20

renal Management major injuries: admit

Answer 20

◆ conservative management with frequent reassessments, serial U/A ± re-imaging
◆ surgical repair (exploration, nephrectomy): hemodynamically unstable or continuing to bleed >48 h, major urine extravasation, renal pedicle injury, all penetrating wounds and major lacerations, infections, renal artery thrombosis

Question 21

Ureter injury management

Answer 21

ureterouretostomy

Question 22

extraperitoneal bladder injury management

Answer 22

◆ minor rupture: Foley drainage x 10-14d

◆ major rupture: surgical repair

Question 23

intraperitoneal bladder injury management

Answer 23

drain abdomen and surgical repair

Question 24

anterior urethra injury management

Answer 24

conservative, if cannot void, Foley or suprapubic cystostomy and antibiotics

Question 25

posterior urethra injury management

Answer 25

suprapubic cystostomy (avoid catheterization) ± surgical repair